National Alliance for Physician Competence Discovery Workshop

Context

  • Welcome: The workshop began with Stephen Miller welcoming the group. Then, participants were provided with an update on a few of the activities that have taken place since the last Summit. Updates included: the Good Medical Practice Document, the portfolio project, and a meeting between licensing boards and certifying boards. Bryan then gave a brief introduction to the workshop and the invited 'catalysts' introduced themselves to the group.

Welcome

 

Stephen Miller

Welcome! Thank you all for coming.

Jordan Cohen

Jordan
The Good Medical Practice document will be the first product of this group to reach the public. This has been an interesting product to go after. It is patterned after the Good Medical Practice document developed in Britain. It's an attempt to articulate our expectations of our colleagues and the expectations that patients have of us. The patient's view of what they expect of a good doctor is very interesting. The physician's view is what they and their colleagues should expect of each other. This is something that could be incorporated by accreditors and standard setting organizations.

As far as I know this is the first time the profession has attempted to put on paper the aspirations we expect of ourselves and our colleagues and the responsibility we have to our patients and the public.

The process has been interesting as well. We've used a wiki and believe it or not the document reads pretty well. For those that haven't seen it it is worth looking at.

This is not meant to be "tablets from on high" but a document to live and grow as it is used. We're not expecting this to be the ultimate, final statement but more like the first step that will be improved over time.

Lynn Langdon

Lyn
Carol asked me to talk about a meeting we had in Philadelphia recently. In the previous Summit there was a small group of us that had a conversation about the trouble we have with each other. We thought we should have a meeting to talk about this. At this meeting there were representatives of the ACGME, FSMB, ABMS, the Osteopathic Board and others. I would report that these groups were talking to each other and that is what is important. Everyone in that room has an overlapping mission - if not a common mission - and in some cases we are in each other's way.

There are 70 licensing jurisdictions and 24 certifying boards. That should give you an idea of the complexity.

There are three follow up actions from the meeting. They are symbolic to wanting to work together. One is to develop a concept paper about the relationship between certification and maintenance of certification.

The second is to narrow the terminology we use for the various licensing behaviors. There are different classifications of things used in the 70 different boards. That is ambitious but it is a beginning.

The last one is to look at individual cases where the certifying decisions and the licensing decisions get botched up. These are catch 22 type situations. There should be a way to cut through that and begin with some boards and some licensing groups talking to each other and creating patterns that can be rippled through the rest of the system. There were many aha's at the meeting.

Jeanne will talk to you about the portfolio project.

Jeanne Heard

Jeanne
The portfolio project is one thing that we've been doing recently. There was a meeting in May under the AAMC and the ABME that brought together a group and that group is producing a white paper about portfolios. The paper is focusing on the continuum and how a portfolio would facilitate many of the barriers we have today.

In October, ACGME, AAMC, FSMB, NBME and others will come together to react to the white paper and talk about the goodness that can come from having a portfolio that talks to other portfolios and would facilitate the continuous development in a streamlined way. Some of you here will be attending that meeting.

We've been talking about the continuum. The accreditors decided we should talk about it together. We had a good meeting about things that get in our way and how we might come together - UME to GME - the natural pathway.

One thing that came out of this was to take the GMP document as a background and align these requirements across these groups - to look at the LCME requirements that would apply to a certain section and the ACGME sets of requirements that applied and where do they align with these competencies.

Bryan Coffman

Bryan
This is a very unusual group and you are unusual for an interesting reason. When we work with clients, without fail at some point, someone will say, "you need to help us think outside the box." One of the truthful replies is to tell them they need to take the time to build another box and look back at their box. Once they hear they have to go through a lot of work to do it they usually step back and push on the box they are in.

This session you are going to build another box so you can look back at the box you are in.

How many of you know who James Clerk Maxwell was? He is the father of electricity and magnetism. He discovered the equations for it. Before he came around people experienced getting shocked and seeing some stones stick together but no one knew how it worked. It was a black box phenomenon.

He needed a key to get inside of the block box. He had to make up the equations and his solution was to use what he knew about hydrology. The myth goes that he sat down and asked himself, "what if electricity flowed like water? What would happen if these equations could be used to work with electricity."

He was an hydrologist. You have to play with things and you have to get some immersion. You have to immerse yourself in it and you have to be willing to play and let those ideas flow. What if you keep playing with these ideas and asked what if this was like this?

We're going to play with how you design and manage and organize an Alliance for physician competence. We're going to talk about how to develop a movement? You can't organize something like this the way the Roman's organized their legions. We have to look at the processes and things that the Alliance might do then see that form follows function. Once you get form in place it kind of dictates what can happen. Once you solidify the form it will allow functions to be done in a certain way and limit other functions.

When we look at something like quality improvement in manufacturing we know that 80% of the quality problems are built into the way the factory floor is designed.

We're going to ask you to think about organization from different vantage points. It's kind of like a particle accelerators. If you hit it and stuff flies out you can hypothesize about what is inside of it. We're going to hit your most widely held beliefs about organization and see what comes out.

We're doing the workshop at a place called Catalyst Ranch. In that spirit we've got six catalysts here tonight. We need to bring in some new people to stimulate our thinking. They will work side by side with you during the workshop. Ordinarily they would present and then leave but this time they are going to work with you.

catalysts

Kirsten Moy - I am with the Aspen Institute in Washington. My unit works with different sectors and my work is with micro-enterprises and how to grow them.

Bill Rouse - I am with Georgia Tech and we focus on how complex organizations change (or don't). There are some successes and you could be one.

Curt Lindberg - I am with Plexus Institute. We're helping people learn about complex adaptive systems and how to implement the concepts and use them in making change.

Marko Rodriguez - I am with the Los Alamos Laboratory and do research on computer models that can be used to make decisions.

Norman Johnson - I've spent 25 years at Los Alamos National Laboratory. It's run by physicists that know the answers and how to do it right. What brought me here is some research on how collectives solve problems and I've become an expert on the failure of experts. Tomorrow you will hear about diversity and strategies in ecosystems.

Our last catalyst is Bob Lindberg. He is a practicing physician and he's applied some of these ideas from Complex Adaptive Systems to his work. Bob will share some stories with us and then there will be an activity after he speaks.

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